Determinants of Anemia Among Pregnant Women Attending Antenatal Care at Public Health Facilities in Gambella Town, Gambella, Southwest Ethiopia, 2025

Background Anemia during pregnancy is a major public health concern associated with adverse health outcomes for both mothers and their newborns. Despite the availability of antenatal care (ANC) services in Ethiopia, anemia remains prevalent, and its determinants vary across settings. However, evidence on the factors associated with anemia among pregnant women in Gambella town is limited. Objective To identify determinants of anemia among pregnant women attending antenatal care at public health facilities in Gambella town, Gambella, southwest Ethiopia, in 2025. Methods An institution-based unmatched case–control study was conducted from May to July 2025 among 250 pregnant women attending ANC at public health facilities in Gambella town. The study included 125 cases, defined as pregnant women with hemoglobin concentrations below 11 g/dL, and 125 controls, defined as those with hemoglobin concentrations of 11 g/dL or higher. Data were collected using interviewer-administered questionnaires and laboratory investigations. Blood and stool samples were examined for malaria and parasitic infections, respectively, and hemoglobin concentrations were measured using the HemoCue Hb 301 + analyzer. Mid-upper arm circumference (MUAC) was measured to assess nutritional status. Data were entered using Epi Info version 7.2.2 and analyzed using SPSS version 27. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with anemia. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and statistical significance was declared at p < 0.05. Results All 250 participants completed the study, yielding a 100% response rate. Rural residence (AOR = 3.65, 95% CI: 1.03–12.90), no formal education (AOR = 3.78, 95% CI: 1.72–8.33), a history of blood loss during pregnancy (AOR = 4.60, 95% CI: 1.16–18.04), a history of malaria (AOR = 4.04, 95% CI: 1.66–9.87), and chronic disease (AOR = 5.82, 95% CI: 1.81–18.74) were significantly associated with anemia. Compared with pregnant women with high dietary diversity, those with low dietary diversity (AOR = 7.10, 95% CI: 1.31–38.60) and medium dietary diversity (AOR = 2.52, 95% CI: 1.17–5.41) had higher odds of anemia. Conclusion Anemia among pregnant women attending ANC in Gambella town was associated with rural residence, lack of formal education, a history of blood loss during pregnancy, a history of malaria, chronic disease, and low or medium dietary diversity. Strengthening maternal health education, promoting dietary diversity, improving the prevention and management of malaria and chronic diseases, and ensuring appropriate clinical assessment of blood loss may help reduce the burden of anemia among pregnant women in this setting.